The Wearing 2 Hats Forum – Cambs & Peterborough NHS Foundation Trust

The forum is an initiative in our organisation that supports staff who have come together with common goals (i) to support staff with their long term conditions (both mental health and physical health challenges, (ii) to support staff who care for their loved ones with their own challenges (iii) to support managers in the role of supporting their staff with lived experience and (iv) to support the organisation to be a more compassionate and caring place to work.

Co-Production

From start: Yes

During process: Yes

In evaluation: Yes

Evaluation

Peer: Yes

Academic: No

PP Collaborative: Yes

Find out more

What We Did

Feedback from our staff through the NHS Staff Survey told us that we could be doing more for staff wellbeing, sickness highlighted that Mental Ill Health is one of the main reasons for working days lost and talking to our staff highlighted that we needed to be doing more to support them emotionally. This is when we decided to set up a support group / forum called The wearing 2 hats. i.e. those of us who are staff and also service users. The forum is an initiative in our organisation that supports staff who have come together with common goals (i) to support staff with their long term conditions (both mental health and physical health challenges, (ii) to support staff who care for their loved ones with their own challenges (iii) to support managers in the role of supporting their staff with lived experience and (iv) to support the organisation to be a more compassionate and caring place to work.

Once we’d decided to set something up, we needed to find out what people needed it to look like, this was done with staff in an anonymous survey to ascertain the views of staff around the issues of mental health. It was from this feedback that the three work streams were developed. The three themes are as follows:

Peer Support – Providing peer support and a safe place to talk about our own experiences. To feel safe to discuss work with people who have been through similar things. This group will feed key themes into the other two workstreams.

Policies and Procedures – Developing guidance for managers and being proactive in supporting better Trust policies. This will support flexibility and thinking of the whole person not just the need to follow a policy. Guidance for managers will support them in ‘staying human’ when dealing with work issues caused through mental ill health, such as sickness absence.

Anti-Stigma – An Anti-Stigma campaign where staff from across the Trust ‘come out’ to talk of their mental health challenges, showing that anyone in any role could be affected by their mental health, and that’s ok. Even better it could help them be a better NHS employee.

How is it making a difference?

The work underway (taking place above and beyond everyone’s usual role) has already started to change the culture in the Organisation. It is fully supported by the Chief Executive (who featured in our Anti-stigma films) and senior leaders, who all appreciate that staff with their own lived experience will support us all in making CPFT a better place to work and receive services. The group have already been working in partnership with HR on the development and review of policies, including sickness and professional boundaries policy. Developing a checklist and some practical guidelines for managers when they are supporting a staff member in work with their own mental health challenges, such as how to time the arrival of letters and how to change the language in templates to cause less anxiety.

We have been instrumental in pushing for a reciprocal agreement which will ensure our own staff can access inpatient support in a neighbouring Trust, if this is required. We are also in the process of helping the organisation establish a ‘staff access pathway’ something that the group feels is essential so that if any staff member becomes unwell they can access timely, appropriate and confidential treatment and support by someone that they feel comfortable with.

Having a forum such as wearing 2 hats, improves how we care for our staff and how we relate to those receiving services. Recovery is at the heart of this group and it supports our new values: PRIDE Professionalism Respect Innovation Dignity Empowerment Along with the behaviours associated with these such as: Kindness, openness, empathy and supporting others in building resilience and feeling empowered.

The anti-stigma work stream aims to help staff feel comfortable to ‘come out’ and talk about their own mental health and celebrate the positives and attributes that having our own lived experience brings to the table. We have developed a range of anti-stigma videos that can be found on our You Tube channel, below are an example of the videos:

The peer support element of the group allows staff to come together in a safe and welcoming space to talk about the issues that are troubling them or they wish to get a shared view on. The group is quickly gaining momentum and gives staff a place to meet to talk about any issues that arise and to help focus their collective energies and make changes and recommendations in the organisation. We appreciate getting to a meeting is tricky for some of the workforce, so have now increased support through a Buddy System, whereby staff can call, visit a member of the team known as a buddy if they feel they need a non-judgmental listening ear and possibly some sign posting to services available to them, or additional support.

Wider Active Support

Partner organisations The group is primarily for staff within our own organisation but we have had a number of queries from staff / managers in partner organisations who want to set up something similar. There are also now a number of staff support groups within other Mental Health and similar Trusts and voluntary organisations and we feel we need to be sharing the work of all of these groups throughout the UK. To have a collective of staff support groups throughout the UK would be something wonderful to strive for. This could really revolutionise the way the NHS supports its staff in mental health services utilising the rich lived experience in its workforce.

Involvement of SU and Carers Wearing 2 Hats is a forum that is completely focused on the needs of staff who are also service users or carers. The membership is primarily staff with their own mental health challenges, staff who care for loved ones with mental health challenges and managers who are supporting staff with mental health challenges which means that its core values are based on recovery. We undertook a confidential survey to ask staff what they thought needed to change in the organisation to support staff more or if they had any innovative ideas that we could try to implement. It was the basis of this feedback that the workstreams, forum and peer support has been developed.

Senior managers Wearing 2 hats is fully supported by the Head of Recovery and Resilience as it fits well with the recovery agenda. It is also fully supported by HR with the Executive Sponsor being the Director of People & Business Development.

It is also supported by the Workforce Executive committee and has high level support from the Director of Service Integration, Deborah Cohen (deborah.cohen@cpft.nhs.uk) and the Chief Executive of the Trust, Aidan Thomas(aidan.thomas@cpft.nhs.uk).

The group have presented to the Trust Board and Wider Leadership Team (top 100 leaders), using the latter to gain more feedback about the difficulties and challenges they as managers have in supporting staff with their mental health, and also gained more members from the senior team.

Co-Production

Everything The Wearing 2 Hats group does includes co-production. Its who we are. Most members have their own lived experience and all choose to be involved in different projects such as the Stay Well At Work Plan, which was co-produced by the group and then piloted in a few teams before being launched to the organisation.

We are the Service Users, the Carers as well as the Staff Members, the managers, the HR team. We Wear 2 Hats – that’s who we are (and many other hats most of the time too!)

Looking Back/Challenges Faced

Looking back- what you would have done differently

About 5 years ago we put out a request to see if staff wanted to come together in a forum to support each other or to help the organisation make improvements to the way staff are supported. Only 2 staff members came forward at this point so unfortunately we decided there was not enough support to make this work, so it went on the back burner. Subsequently we put this opportunity out to the organisation about 3 years ago and no-one came forward at all, so once again it was shelved. However more recently there seemed to be an appetite for staff to come together with the purpose of supporting each other, so we put out a request again and we had about 20 people contact us to say they would be interested. This continues to grow each time we meet and as more people ‘come out’ about their own challenges then it paves the way for other staff to do the same.

I think in hindsight what we should have done years ago was brought the 2 people together to form a small group and then see if it would gain momentum as it has done this time. I think by not doing this we may have lost several years’ worth of positive work that we could have achieved.

Challenges and how you overcame them

One of the challenges that we have encountered is for managers to provide protected time for staff to attend the forum, rather than it feeling as though this is luxury time out. With the increase in workloads and a shortage of resources staff feel under pressure to do more, and often this means that the support they need themselves gets neglected. By promoting the Wearing 2 Hats forum through Senior Leadership group and through HR and Occupational health. The Wearing 2 Hats group is seen as part of the support network that keeps people well and at work. We have also added a Buddy scheme, which is an initiative that has evolved out of the Wearing Two Hats group and is designed to provide a listening ear to colleagues within the Trust who have their own mental health challenges and are in work but may be having a particularly bad day. Several colleagues, some of whom have their own lived experience and others who are “allies” (ie people who do not have lived experience but are passionate about this issue) have volunteered to become “buddies”.

Our Organisation has changed considerably since the group started, having moved from a predominantly Mental health Trust to an Integrated Care Organisation. The language we use such as ‘Recovery’ is not as well understood by those in the physical health side of the Trust. So more thought is needed when promoting who we are and what we can offer. It has also highlighted that we have other staff with lived experience of conditions such as; Diabetes, Irritable Bowl Syndrome, Cancer and Stroke, they also wear 2 hats. So we have opened up the groups remit further to support, represent and lobby on the issues of staff with any long term condition.

Another challenge was the number of staff who were keen to be updated but didn’t want to be seen as being involved, due to the Stigma associated with mental health. The number of staff feeling this way has reduced, with more now coming to the meetings and feeling comfortable in opening up to their managers and colleagues. Again, the engagement with Senior Leaders and the Anti-stigma campaign, along with the increasing numbers attending each meeting has highlighted that they are not alone.

Sustainability

The group has different leads for the different workstreams. Each workstream has input from other members of the group, this supports the group in being more sustainable.

The Trust has recently re-launched the Diversity Network, who wish to provide the strategic direction, energy and momentum for promoting and maintaining equality and diversity across the Trust. This has bolstered the structure and also the support for the Wearing 2 Hats group. They champion the work of the Wearing 2 Hats group and again will support the sustainability of the group.

The group has a terms of reference and has flexibility built in, so as we feel a workstream is completed we will move on to the next relevant thing, constantly asking for feedback and constantly moving the agenda forward.

Evaluation (Peer or Academic)

We have now been running for almost 2 years and …

The programme has not been formally evaluated, however it does form part of the Health and Wellbeing Strategy and in turn the Workforce Strategy (5 years). In this time we have seen improvements in both how staff feel supported around their health and wellbeing and their engagement in the Trust. Our Staff Survey has highlighted the following:

% would recommend Trust as a place to work, in improvement from 35% in 2014 to 51% in 2016.

% agree with ‘my immediate manager takes positive interest in my health and wellbeing, an improvement from 62% in 2014 to 73% in 2016.

% agree with ‘my organisation takes positive interest in my health and wellbeing’, a deterioration from 36% in 2014 to 31% in 2016.

Whilst it is disappointing that staff feel the Trust takes less of a positive interest in their health and wellbeing, the majority of the work the Wearing 2 hats groups have completed are around supporting managers to better support staff, which has increased from 62% in 2014 to 73% in 2016.

Outcomes

Whilst above highlights the quantitative evidence around the success of the Wearing 2 Hats, we believe it’s the change in culture, and qualitative feedback that we receive that indicates the real differences its making for our staff, and in turn our colleagues and service users.

Wearing 2 Hats is developing our culture and interactions so we are more supportive, better equipped and not afraid to have positive conversations about mental health.

Here are some of the quotes we have received from members of the Wearing 2 Hats group and those who have used the buddy system:

• “I don’t know what I would have done without the support I received from staff member x (W2H) without this I would not be back on my recovery journey and be back at work.”

• “I was fortunate to be involved in the W2H and peer support groups almost from the beginning and having them within the Trust has helped it to feel a lot more human and supportive than other Trusts I have worked for. It has given me the opportunity to support colleagues and be part of the setting up of a buddy system for those struggling with mental health issues at work and needing a confidential listening ear. I, in turn, have benefited from that listening ear and not felt the least bit stigmatised or disrespected for having the need. It has also exposed me to others in the organisation who really care about their colleagues and encouraged me that despite it being a huge organisation we can, little by little, influence it for the better.”

• “It has offered such an opportunity at all levels for staff with mental health needs to be honest, ask for support when needed and for our opinions to matter.”

• “Having a forum of W2H gives me, as a staff member, the valuable space to be a part of shaping the care for colleagues who live with their own mental health challenges.”

• “I would also especially like to thank staff member X from the W2H initiative. If it wasn’t for her support I don’t know what I would have done. She is a true asset to CPFT.”

• “I feel wearing Two hats is a brilliant portal for finding out more information on working and living with mental health within CPFT.”

• “Its been great to get some feedback on our processes and policies from people who have been on the receiving end of them, some great changes have been made thanks to the Wearing 2 hats acting as a lobbying group as well as working in partnership with HR.”

• “I am so thrilled that we have developed our W2H forum, I am able to be open and honest about my mental health challenges in a safe, welcoming and compassionate environment.”

• “I have never felt able to disclose my mental health issues to my manager but with the support of the W2H forum I feel this is something that I will now try to do.”

• “The stigma associated with mental health is enormous and I think this is even more so working in a mental health organisation. The w2h forum is a brave step to rise our heads above the parapet and sing the praises of the courageous staff members who live with their own mental health challenges as well as working as professional in mental health services.”

• “I am proud to be a member of w2h and I absolutely believe that I am a better and more compassionate manager / staff member because of my own challenges.”

Sharing

Commitment to Dissemination

The forum and the peer support group are committed to sharing the learning with the rest of the organisation and its wider partners. There are now a number of staff support groups within Mental Health Trusts and we feel we need to be sharing the work of all of these to wider NHS organisations and mental health services.

We are also part of a health and wellbeing network group (Cambridge Biomedical Campus Wellbeing Network) in Cambridge, whereby documents, posters and leaflets about the group have been shared with other NHS, third sector (Mind) and Private organisations.Is there any other information you would like to add?

The wearing 2 hats initiative was recently awarded a highly commended achievement from our own good practice awards. (April 2016).

It goes without saying – We have Pride in our lived experience.

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